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WO2007017211A2 - Procede et dispositif d'application de radiotherapie - Google Patents

Procede et dispositif d'application de radiotherapie Download PDF

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Publication number
WO2007017211A2
WO2007017211A2 PCT/EP2006/007762 EP2006007762W WO2007017211A2 WO 2007017211 A2 WO2007017211 A2 WO 2007017211A2 EP 2006007762 W EP2006007762 W EP 2006007762W WO 2007017211 A2 WO2007017211 A2 WO 2007017211A2
Authority
WO
WIPO (PCT)
Prior art keywords
positioning
items
patient
respect
prosthesis
Prior art date
Application number
PCT/EP2006/007762
Other languages
English (en)
Other versions
WO2007017211A9 (fr
WO2007017211A3 (fr
Inventor
Régis Ferrand
Samuel Meyroneinc
Hamid Mammar
Jean-Claude Rosenwald
Alejandro Mazal
Original Assignee
Institut Curie
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Institut Curie filed Critical Institut Curie
Priority to US11/997,865 priority Critical patent/US20080317203A1/en
Priority to JP2008524452A priority patent/JP2009502383A/ja
Priority to EP06776632A priority patent/EP1924324A2/fr
Publication of WO2007017211A2 publication Critical patent/WO2007017211A2/fr
Publication of WO2007017211A9 publication Critical patent/WO2007017211A9/fr
Publication of WO2007017211A3 publication Critical patent/WO2007017211A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A61B6/0487—Motor-assisted positioning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb
    • A61B5/1126—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb using a particular sensing technique
    • A61B5/1127—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb using a particular sensing technique using markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/40—Arrangements for generating radiation specially adapted for radiation diagnosis
    • A61B6/4064—Arrangements for generating radiation specially adapted for radiation diagnosis specially adapted for producing a particular type of beam
    • A61B6/4092—Arrangements for generating radiation specially adapted for radiation diagnosis specially adapted for producing a particular type of beam for producing synchrotron radiation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/548—Remote control of the apparatus or devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1085—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy characterised by the type of particles applied to the patient
    • A61N2005/1087—Ions; Protons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1069—Target adjustment, e.g. moving the patient support
    • A61N5/107—Target adjustment, e.g. moving the patient support in real time, i.e. during treatment

Definitions

  • Instant invention relates to methods and apparatuses for positioning a body such as a living body and their application to radiotherapy.
  • a positioning system has been proposed which comprises an industrial robot having six degrees of freedom.
  • a support for a patient like a chair or a couch, is mechanically coupled to the wrist of the robot arm and a learning process is applied to prepare movement of the patient from a docking position to a treatment position.
  • Such a prior art has been illustrated in a Conference
  • Proton beams are produced from a particle accelerator, namely a proton-synchrotron, which has many drawbacks. Firstly, it is costly due to the heavy mass and volume of the equipment, the use of rare components and services. Therefore, any protontherapy device should be able to treat a sufficiently high number of patients to reduce induced costs for each individual treatment. Secondly, exposure to the vicinity of the beam is extremely severe. Therefore, it is highly recommended that no service agent be inside a security area around the patient under treatment. Thirdly, it is well-known that high-energy radiation beams are very noxious for any healthy living tissue around the precise location of the targeted tumor or body part.
  • the patient will be submitted to a succession of treatment sessions and it is important that the patient be replaced back each time in the right position with respect to the beam in a simple, fast and non-costly way.
  • An object of the invention is to improve the methods and apparatuses for positioning a body, for example in a context of a radiotherapy treatment.
  • a method for positioning a living body which comprises:
  • the method of the invention could also show any of the following features:
  • the number of items in the group is less than the total number of positioning items
  • each positioning item belongs to groups comprising different combinations of positioning items; - some of the values being above their corresponding threshold and some others not, determining if at least one of the items belongs to groups associated with the above value without belonging to the other groups, and if yes, determining which it is; - after the body has been moved, the measuring and determining steps are performed again with the previously measured locations used as reference locations replacing the former reference locations; and
  • a device for positioning a living body comprising means for measuring a location of a plurality of positioning items, and means for determining from reference locations of the positioning items and the measured locations if at least one of the positioning items moved with respect to at least another one.
  • an apparatus for moving a living body comprising a device according to the invention.
  • a non invasive method for positioning a living body comprising setting a prosthesis including at least a marker to both X-rays and nuclear magnetic resonance, into at least one natural body cavity.
  • the method of the invention could also show any of the following features:
  • the prosthesis is formed according to the proper shape of the said body cavity, personalized for each patient anatomical features in order to ensure a good reproducibility of positioning between each treatment session;
  • the prosthesis or at least one of the prosthesis belongs to the following group: a mouth prosthesis, a nose prosthesis, and an ear prosthesis;
  • the prosthesis or at least one of the prosthesis comprises at least two markers spaced from each other; and - the number of prosthesis set onto the body is at least 2, 3 or 4.
  • a prosthesis shaped to be set into a natural cavity of a living body and including at least a marker to both X-rays and nuclear magnetic resonance.
  • the method of the invention could also show any of the following features:
  • the feature or at least one of the features is chosen from the group consisting of:
  • the device is controlled so that the body remains in a predetermined area smaller than any area comprising all the possible locations of the body moved by the device.
  • an apparatus arranged for moving a body, such as a living body, between initial and final positions by deforming itself along one among a plurality of possible configurations enabling this movement, the apparatus comprising control means which enable to choose the deformation configuration according to at least one cinematic feature of the configuration.
  • an apparatus for moving a body with respect to a base of the apparatus comprising holding means for holding the body during a movement and comprising at least two different items, at least one of which being arranged to carry the body, the apparatus being arranged to detachably fix any of the items to the holding means.
  • a treatment method such as a method for treating a tumor by radiotherapy, which comprises a method according to the invention.
  • an apparatus for positioning an object contained in a body with respect to a particle beam comprises carrying means for carrying the body.
  • said apparatus further comprises moving means for moving the carrying means accord ing to several degrees of freedom with respect to a base of the apparatus, said base being able to rotate with respect to an axis, named isocenter axis, which is intended to pass through an isocenter defined in the object.
  • the apparatus is adapted to position the isocenter of the object on the isocenter axis which is the rotation axis of the base of the apparatus.
  • the body is a patient in a context of a radiotherapy or protontherapy treatment.
  • the particle beam can be a proton beam and the object can be a tumour which is intended to be fired by protontherapy.
  • the present embodiment of the invention it is possible to realize an automated patient positioning in a simple, fast and non-costly way. Indeed , one can use an isocentric rotation of a patient which is intended to support multiple fields in a same plan within a same session of treatment for example.
  • the object isocenter which is linked to the robot is kept without correcting its localization once again. Therefore, the same isocenter being defined at a computer, a plurality of beams can be fired in sequence, only one rotation movement of the patient around isocenter being performed between two successive firings.
  • Such an embodiment permits to avoid the computations or mathematical correction of 3D positions of markers used to correctly position the patient.
  • a method for irradiating an object, such as a tumour contained in the head of a human body, by multiple fields or directions, by using an apparatus according to the present embodiment can comprises the steps of:
  • the particle beam propagates according to a particle beam axis which intercepts said isocenter axis.
  • the isocenter axis can be vertical and/or perpendicular to the beam axis.
  • the isocenter axis and/or the particle beam axis can be fixed with respect to a room in which the apparatus is disposed .
  • the carrying means is of the type of a chair. With the present apparatus, eye and head treatments can be made in a limited space.
  • the carrying means can comprise means for lateral and/or axial displacement of the patient with respect to the chair.
  • the seat of the chair can be combined with one or several actuators ("verin" in French language) provided for moving the seat up with respect to the chair.
  • the carrying means can also comprise means for slightly positioning the body head with respect to the chair. Particularly, the head always overhangs the rest of the body.
  • the moving means comprises six degrees of freedom, in particular 6 arms.
  • the 6 arms are independent, each being connected at a first end to the carrying means and at the second end to the base.
  • the connection is articulated.
  • the six arms are arranged in such a way that two neighbouring arms form a "V", the point of "V" facing successively up and down when the base rotates by 360°.
  • the six arms are telescopic.
  • the apparatus is controlled by a supervisor computer.
  • the apparatus is further equipped with inclinometers bi-axes, accelerometer tri-axes, anti-collision system and speedmeters, in particular six speedmeters, one per arm.
  • FIG. 1 shows a top view of a treatment room built specially to perform the method according to the preferred embodiment of the invention with an apparatus according to the invention
  • FIGS 2 and 3 are lateral views of an industrial robot which is part of the apparatus according to the preferred embodiment of the invention of figure 1 , on which are affixed two respective means for carrying the body of a patient to be treated
  • - Figure 4 is a perspective view of the robot of figures 2 or 3;
  • FIG. 5 is a schematic view of both steps for acquiring images before and during treatment
  • FIG. 6 shows both lateral and front views of means for forming a treatment beam
  • FIG. 7 to 8 are flowcharts showing different steps of the method of the invention according to the preferred embodiment
  • FIG. 9 shows a schematic perspective view illustrating a step of the method in which a missing or displaced marker is detected ;
  • FIG. 10 is a schematic lateral view of an alternative embodiment of the apparatus of the invention.
  • FIG. 1 1 is a schematic view of an isocenter positioning robot holding a body
  • - Figure 12 is a schematic view of the entire isocenter positioning robot; and - Figure 13 is a lateral schematic view of a seat of the isocenter robot chair.
  • Figure 1 illustrates a room where is performed the method according to the preferred embodiment of the invention.
  • the treatment room is built with convenient materials to ensure radioprotection at the vicinity of a particle generator 18.
  • the generator comprises an elongate tube 14 which enters inside the treatment room.
  • the axis of this tube serves as a reference axis for movements and treatments of patient inside the room.
  • the room comprises two parts:
  • Both parts are separated by an angulated wall shown between elements 12 and 16 which are described below and a door (not shown but located at the place of an element 36 which is also described below).
  • the room is separated from its environment by walls and the two parts of the treatment room are also well separated from each other by the wall, all of which have been drawn with hatched lines.
  • the entrance is protected against radio emission by the wall when treatment is performed.
  • the treatment part of the room comprises:
  • a docking station 20 which comprises a static part affixed to the ground of the treatment room is provided in the second zone.
  • Docking station 20 carries a reference part 34 and fixture means which match with corresponding reference parts and fixture means of both patient supports 7 and 8.
  • the robot also carries corresponding reference parts and fixture means formed to match with those of the patient support means.
  • Phantom tank 21 comprises a container filled with water or any convenient reference material both for control of the treatment beam and x-ray imaging means which will be described hereinafter.
  • Imaging means are operative during a setting step of the method as it appears below.
  • a station 12 is provided at the door between entrance and treatment parts, which includes electronic and electrical means for controlling robot 10 and imaging means 40, 42 and 44.
  • at least one operator controls the robot and imaging means at the station 12 acting on a terminal (not shown) to prepare treatment of the patient.
  • some programs are run to prepare each sequence of movements.
  • the operator Before the treatment begins, the operator should go back to the entrance part of the room in front of a terminal of processing means 16 which helps him to control and fires the treatment, patient being positioned by the industrial robot to ensure a secure and precise treatment with the at least one particle beam radiated from tube 14.
  • robot 10 which comprises an arm 3 presenting six degrees of freedom.
  • Robot is settled in pit 1 which is covered and protected with a lid or cover 2 which is built so that the robot arm 3 rises above lid 2. No opening is visible on the lid. Therefore, nobody could fall in.
  • the lid 2 comprises a rotating part which rotates on pit 1 with the movement of the arm 3 of the robot and a translating part which follows movements of arm 3 by sliding in the rotating part of the lid.
  • a base 4 of the robot is affixed on the ground.
  • the other linear sections of the arm are connected by joints until a terminal wrist 5 which is equipped with a fixture part 6 which engages with the coupling part of the support means like the couch 7 illustrated on figure 2 or the chair of figure 3.
  • a fixture part 6 which engages with the coupling part of the support means like the couch 7 illustrated on figure 2 or the chair of figure 3.
  • same elements are marked with same reference numerals.
  • each part of the arm which could be in contact with objects or persons is provided with contact detectors which are electrically connected with the means implemented in station 12 for controlling the movement of the arm.
  • each contact detector is built under an elongated shape comprising a lever mounted on at least two springs and an electrical contactor which changes its electrical state when the lever is pushed when any contact on its length occurs.
  • Figure 4 more precisely shows the industrial robot with its six axes, AXE 1 to AXE 6, with a terminal fixture part 6 and the elongated contact detectors such as 68 which appears at the side of the last section of the arm 6.
  • the static part 4 of the robotic arm is provided with means 60 for fixture to the ground of the pit.
  • the robot may be a parallel robot with at least two legs supporting a wrist on a fixed base.
  • a coupler is provided at the end of the arm and a complementary part of the coupler is affixed onto the support means for patient.
  • the coupler here is an electro pneumatic one in which a contact is open at an opening command and closed at a closing command so that patient supporting means could be released under control of station 12.
  • Each one of the patient support means is provided with means (not shown) to firmly maintain the patient in his seating or lying position, especially during all the treatment.
  • station 12 When a given support means for a patient is posted to the docking station, it is recognized by station 12 for controlling the robot on the basis of a numerical identifier.
  • a recognition means to this end could be an electrical switch having a plurality of electrical contacts some of them being connected or not to generate the proper numerical value of the identifier.
  • recognition means comprises a vision tool having at least a vision camera coupled to a computer running a pattern recognition program to perform recognition of the actual support means which is presented at the docking station and also to control the coupling movement of the robot to the support means.
  • a hand-control (not shown on the drawings) at the side of the arm with a terminal which is linked to the actuators of the arm to learn trajectories of the end of the arm under control of an operator;
  • All these three control devices are programmed under a hierarchical organization so that in case of failure, the hand- control at the side of the robotic arm may take control to such an extend that even if the control station 16 and the control desk 12 are disabled, the whole system could still be run.
  • the robot in this embodiment shows some features aimed to enhance security of the operations It contains urgent stop-buttons, for stopping any actuator in case of emergency.
  • Anti-collision bands are mounted at the sides of the robotic arm and at the sides of the patient supporting means.
  • the program controlling movement of the arm is designed to only permit movement of the patient with given limited speed, acceleration, and angles. Means are also provided for avoiding unwanted movements whenever treatment is running and/or if power fails. To ensure this, at each joint of the arm, gears are mounted which are always active at the end of movements and/or when power is off. Brakes are provided as well which are also active at zero power. To enhance security within the treatment room, brakes are automatically activated when power is cut off, so that movement of the robot is not possible, unless mechanical coupling means are released.
  • Instant method takes into account the longitudinal deformation of the robotic arm when it is loaded and/or moving. To this view, movement of the arm is first analyzed with a set of reference loads of known weight.
  • the first moment of movement with its linear and angular acceleration is recorded each time so that a memory of the dynamic response in flexion is memorized.
  • some load detectors and/or accelerometers provided at the wrist are read. Signals produced by load detectors and/or accelerometers are processed to address a bending table or a function which is used to correct and/or adapt movement and localization and/or orientation of the patient at the treatment zone 30. Accordingly, in instant embodiment, the detection signals from the detectors are compared with a dynamic response stored in the memory of the control computer to adapt and correct the dynamic response of the arm.
  • a patient has been diagnosed with any disease such as a tumor which could be treated with the particle beam (here a proton beam) produced in the treatment room of figure 1 , the following occurs: I .
  • the tumor of the patient to be treated is located and some markers are disposed onto the patient;
  • Imaging of both markers and the body part to be treated is done to produce a database of images with identification of the patient. Imaging is done for example with combined use of X- rays, IRM or PET scan means;
  • Time, duration, axes and power for each designed treatment beam are determined by physicians and ascribed in a database with identification of the patient to help operators in controlling the treatment;
  • a collimator or diaphragm is formed in a material able to arrest particles of the treatment beam outside the body part to be treated (see Figure 6).
  • Collimator is designed to be mounted at the end of tube 14 connected with particle generator 18, before patient will be treated;
  • phantom tank 21 is mounted at the end of the robot arm, is positioned and oriented to intercept the particle beam radiated from tube 14 so that beam dosimetry can be performed;
  • the patient is loaded into the treatment room and installed on his support means (chair 8 or couch 7);
  • the support means is moved to the docking station 20 so that reference means 32 or 36 engage with reference means 34 of the docking station 20.
  • a first detector (not shown at the drawings) is provided at the side of the docking station so that the type of support means is detected and recognized to allow control means of the treatment room to set correct parameters corresponding to the type and geometric shape of the support means. Such information permits to precisely specify the area in which the robotic arm should be moved with patient onboard.
  • a second detector (not shown) at the docking station is connected to station 12 to ensure that a signal indicating the beginning of the learned movement of the arm is detected by the control means at station 12. 9.
  • the arm performs the learned movement of its wrist so that it moves the support means from the docking station to the treatment zone 30, the patient having at the end of the movement the computed position (place and orientation) relative to the axis of tube 14; 10.
  • imaging means 40, 42, 44 are used to generate at least two non collinear digital 2D images of the body part to be treated, showing the markers of the body of the patient and the tumor.
  • the images are transmitted to the computer installed at terminal 16. There, the 2D images are processed to calculate actual absolute position of the patient's markers and to compare it with absolute 3D reference positions stored in a database;
  • these newly generated images are compared with the reference images of the database to detect if the markers are present and at the right position and if a predetermined point such as the isocenter of the body part to be treated is located at the correct position (location and orientation) relative to the axis of tube 14. If the positions are correct, treatment beam is fired. If not, robotic arm is controlled with computer 16 to correct the position of the patient. Once the correct position is reached, treatment beam is fired.
  • the body part also needs to be irradiated with the beam from another side that is to say with another orientation of the patient with respect to the beam.
  • the patient is moved in order to have this new orientation, its position is checked and if necessary, modified until the intended new position is reached. Then the beam is fired. The same steps are performed for each firing associated with a new orientation, if any. 1 3.
  • patient is moved back to the docking station. Its support means is disengaged from fixture means of the robotic arm. The arm goes back to the pit
  • the "user" referential (referential well known in robotics which corresponds to the target such as a car door in the case of a painting robot) is put in coincidence with the irradiation beam.
  • the two other robot referentials are the “world” referential (corresponding to the base at the foot of the robot) and the tool referential (the end of the arm holding the tool, here the chair or the bed with the patient).
  • Positioning is performed only once to put the tool (the patient) on the beam and may be automatically readjusted in real time, for example if the target is moving (tracking). Basically, this feed back principle is used to put the tool (the patient!) on the target.
  • the patient is maintained into a fixed position (attached on a bed for example), and the beam may be moved around the patient (such as a 360° rotation) without the need to reposition the patient.
  • the beam may be moved around the patient (such as a 360° rotation) without the need to reposition the patient.
  • a plurality of markers 82 is used .
  • markers are inserted in or affixed to the body part of the patient, which is here a head with a skull 70.
  • Each marker cou ld be made in a biocompatible material like gold , titanium or tantalum and be ball-shaped .
  • the radiation oncologist or surgeon applies two, three and preferably four markers. The surgeon could insert each marker firmly at the surface of the skull at some particular locations or insert the markers inside the patient head as showed on figure 5, in a known manner.
  • markers 82-1 to 82-4 are inserted in or around a body part 78 to be treated with the proton beam.
  • a cancerous tumor of the eye or the head is inserted in or around a body part 78 to be treated with the proton beam.
  • Markers may comprise a part which can be imaged and a part adherent to the skin of the patient.
  • markers may be affixed onto a part of patient supporting means and preferably onto contention means which are supplied to securely binding patient onto his supporting means.
  • Such markers could be some predetermined parts of the contention means like metallic parts of the links or bands to affix patient, and/or predetermined marks which shape and position are predetermined to generate convenient 2D images when patient is submitted to X-rays imagers as described above.
  • markers in the shape of balls may be settled into the skull or the head of the patient. But there exists a need for another technique which is less invasive.
  • markers form parts of two plastic tubes which can be inserted into a body natural cavity or orifice such as an ear, the mouth or the nose.
  • Each tube comprises at least one metallic ball which can be imaged with X-ray or other imaging systems like ultrasound waves or infrared imagers.
  • Tubes can also comprise in addition some gadolinium in order to be imaged as well with MRI.
  • Each tube may contain several X-ray markers 172a and 172b and
  • the tumor 170 inside the skull has been schematically drawn and should be treated by applying the proton beam.
  • Axis of X-ray beam is shown at 176 and spots of the markers of the two tubes 172 and 174 are referred as squares A' or B'.
  • the space occupied with tumor 78 is represented on the first image 178 at 182 and the spot of the isocenter of the reference coordinate system linked to the tumor has been drawn at 186. Later, patient is settled on the robotic arm, and then moved and oriented, both the tubes 172 and 174 being in place.
  • At least a second image 180 is then acquired by using one of the X-ray imaging systems 40 - 44 at the treatment room, to correct the patient position before proton beam can be fired at tube 14.
  • the second X-ray image shows that two markers are displaced in A and B and therefore orientation and/or localization should be corrected.
  • instant method comprises setting a prosthesis including at least a marker into at least one natural body cavity.
  • the prosthesis is formed according to the proper shape of the said body cavity (for example by molding directly on the patient's body) and belongs for example to the following group:
  • the marker is a marker for at least one non visible radiation of the following group: X rays and nuclear magnetic resonance and preferably both.
  • the prosthesis or at least one of the prosthesis may comprise at least two markers spaced from each other and the number of prosthesis set onto the body is at least 2, 3 or 4.
  • At least one of the markers may be part of a prosthetic part inserted into the orifice or cavity of the patient's body.
  • a prosthetic part is preferably an audio amplifier inserted into the ear, or an artificial tooth.
  • This prosthesis could also be intended to be fixed against the palate of the patient's mouth.
  • the marker could also be part of a surgical implant on the backspin or on arms or legs.
  • An important parameter to define the proton beam is the presence of living tissues around the targeted tumor 78. These living tissues should be protected when proton beam is radiated. Therefore, precise orientation of the skull 70 in view of orientation of the proton beam should be defined.
  • a coordinate system associated with the patient and the future beam is used to ensure that parameters of the correct orientation are specified.
  • at least two 2D images of the markers and tumor are acquired, which are perpendicular to each other and stored into the database with the patient ID and the treatment session ID. This enables to identify absolute reference positions (place and orientation) of the patient with respect to the room and accordingly the beam, by means of the absolute reference coordinates (x, y and z on three perpendicular axes) of the markers and tumor.
  • 3D-absolute reference coordinates of the markers and tumor with respect to the fixed referential of the room are computed and stored in the database. This will permit to configure treatment with both movements of the robotic arm and firing of the proton beam.
  • X-ray imaging devices 72, 74 comprise a X-ray source 72 and a detector plate 74 to generate a 2D image of densities of the skull 70.
  • markers 82 should be represented on the numerical image which is stored at the input 76b of the database manager 76.
  • database manager 76 For each acquired 2D image, database manager 76 generates a plurality of parameters comprising:
  • the reference coordinates system 80 comprises three axes and an original point.
  • the original point is denoted "isocenter” and referred to be a preferred point for applying a proton beam when the treatment of the patient is running.
  • isocenter a preferred point for applying a proton beam when the treatment of the patient is running.
  • the database of 2D images could be acquired on the basis of visible images recorded onto a transparent carrier as is well-known in the art of recording X-ray analogue images.
  • the output of each of them is connected to the respective input 76a, 76b, 76c at the database manager and the same as described above for x-ray imaging system 72-74 is repeated for the one or two others.
  • the same isocenter and the same reference coordinate system are used for the two or the three X-ray imaging systems.
  • the plurality of records for the tables loaded in the database manager 76 is controlled on the basis of: - the name or unique identification ID_Patient of the patient and possibly of his tumors if there is more than one tumor to be treated;
  • the patient is positioned in the treatment room in front of the tube 14.
  • Markers on the patient are imaged by means of two 2D images and the same computation as above takes place, to calculate this time the actual 3D-absolute coordinates of the markers in the instant actual position (place and orientation) of the patient. Any variation of the patient position is now detected. Precisely, this step makes use of the above-mentioned 3D- absolute reference coordinates of the markers, as previously acquired, and of the actual 3D-absolute actual coordinates of the markers, as newly acquired. If an offset is detected, new positioning of the patient (change of place and/or orientation) is executed with the robotic arm. Once the correct position is obtained, the treatment beam is applied onto the patient according to data.
  • Figure 8 shows the different steps of each treatment session.
  • the patient is prepared to follow his treatment.
  • operator uses arm control station 16 to enter the movement parameters for the path of the patient supporting means from the clocking station to the treatment zone. After movement and other controls of the robotic arm are loaded in the robot computer, patient is settled on his supporting means. He is attached to it to lessen his freedom of movement with any convenient contention means at step 126.
  • patient supporting means is fixed at the docking station.
  • robotic arm is coupled to the patient supporting means.
  • such an operation is effected with a stop and lever assembly, one being associated with the wrist of the robotic arm and the other with the patient supporting means.
  • reference coordinate system at robotic arm is identified to the reference coordinate system associated with the patient supporting means that is to say the room.
  • each programmed proton beam is fired sequentially as it is explained below.
  • the arm (carrying on its wrist patient supporting means with the patient to be treated) is moved and oriented on the basis of the data recorded in the database 76. It leads the patient from the docking station to a reference point along the central axis of the proton beam which will be fired. At that reference point is settled the isocenter of the tumor to be treated as defined in the database 76.
  • instant method is used for controlling the robot to move the body between initial and final positions by deforming the robot (having six degrees of freedom) along one among a plurality of possible configurations enabling this movement.
  • the deformation configuration is chosen according to at least one cinematic feature of the configuration which could be chosen for example from the group consisting of:
  • the robot is preferably controlled so that at least a deformable portion of the robot is not deformed during the movement.
  • the device is controlled so that the body remains in a predetermined area smaller than any area comprising all the possible locations of the body moved by the robot.
  • means are provided for controlling the movements of the arm with the patient supporting means.
  • Such a control means is programmed to command a trajectory of at least the patient supporting means at the end of the robotic arm from its starting position at the docking station to the treatment position in front of the tube 14 so that trajectory is free of colliding risk.
  • These means cooperates with means for specifying a free movement space at the request of the operator in which any trajectory is calculated.
  • These means for controlling movements of the arm also cooperates with means for classifying a degree of risks of any movement of the arm and to request a choice form the operator (or the computer) in a list of classified movements from the less risky to the most risky movement.
  • the means for classifying also comprises means for automatically selecting a movement in the said list of movements with another constraint comprising: - Maximum speed and/or acceleration (linear and/or circular) authorized for a given patient and/or a given supporting means; and
  • a means is provided for setting some axes of the robot to be non moveable, at least a part of the movement being executed with the other axes varying. It should be understood that, if the robot is replaced with another robotic apparatus like a parallel robot, the same applies for.
  • X- Ray imaging system 40 - 44 acquires one to three 2D images of the skull of the patient at the position (place and orientation) given by the robotic arm before proton beam can be fired.
  • robotic arm modifies localization of the isocenter and orientation of the patient with respect to the central axis of the proton beam to correct the position.
  • the computer runs a program which reads in the database the data of the reference position of the markers. Then, it reads the data corresponding to the actual position of the markers and deduces control parameters to program movements of the robotic arm to perform a correction of the localization and/or orientation of the isocenter of the tumor.
  • instant method comprises the steps of: - measuring a location of a plurality of positioning items such as the markers; and
  • the method comprises the step of determining which it is and positioning the living body by using the positioning items except this one.
  • the method comprises, for at least one of the pairs of the positioning items, comparing the distance between their measured positions and the distance between their reference positions, preferably by making the comparison for all the positioning item pairs.
  • the method comprises, for at least a predetermined group of positioning items, calculating a value which takes into account for each item the distance between its measured position and its reference position, and determining if this value is above a predetermined threshold.
  • the number of items in the group is at least 3. But for the group or at least one of the groups, the number of items in the group is less than the total number of positioning items. Calculation and determination are made for a plurality of the groups so that each positioning item belongs to groups comprising different combinations of positioning items.
  • the method comprises determining if at least one of the items belongs to groups associated with the above value without belonging to the other groups, and if yes, determining which it is.
  • the measuring and determining steps are performed again with the previously measured locations used this time as reference locations replacing the former reference locations. Both determination steps may be performed on the same day or on different days.
  • the actual images of the markers are digitized by the computer to obtain sets of 3D coordinates corresponding to the actual position of the markers
  • database manager 76 is addressed with the identification of the patient to be treated.
  • the 3D coordinates corresponding to the actual position of the markers are compared with the 3D reference coordinates of the markers stored in the database. To this end , for each marker the computer calculates the distance between the actual and reference positions of the marker at step 156.
  • each marker is deemed to be in its reference position and not to have moved.
  • the isocenter of the tumor is deduced from the set of the markers actual coordinates. And an "end” operation is performed at Step
  • step 158 if an error occurs, that is if one distance does not equal zero, this means that at least one marker has moved and it is signaled to the control computer. Then, the next steps are aimed at identifying the moved marker(s).
  • n markers In the case of n markers, a loop is generated to monitor each group of any combination of p markers among the n markers with 1 ⁇ p ⁇ n.
  • the method consists in verifying the distances between all the possible pairs of markers.
  • the actual distance is calculated and compared with the distance in the reference position of the markers stored at database manager 76.
  • the method consists in trying to match by optimization the reference pattern and the actual pattern. If the match criterium is above a certain threshold, it means that the patterns are different and that one or more markers have moved.
  • an example of such a value is as follows. For each marker, the Euclidian distance offset measured between actual and reference positions of the markers is calculated. The value is the sum of the square of these offsets for the markers of the group, or preferably the square root of this sum.
  • the value may be null, which means that the markers of this group did not move with respect to each others.
  • the value may be above zero, which means that at least one the markers of these groups did move with respect to each others. If such an offset is detected, a test is performed to identify the moved marker(s) or even the missing markers if any.
  • a plurality of threshold values is used to specify if the offset is acceptable or not.
  • ⁇ TV J ; i ⁇ be a set of predetermined threshold values as required according to the number of markers.
  • ⁇ ODj; j ⁇ be a set of all the offset distances measured at the preceding step.
  • a variable counter CPT k is incremented each time a logical condition expressed as (ODj > TVi) is verified with marker k.
  • Two reference values A ⁇ B are selected by the operator at station 16. If a given k th counter is greater than a first reference value A (CPT k > A), then the presumed k th marker is declared as being misplaced and if CPT k > B, then the presumed k th marker is declared as being indefinite.
  • a counting is also performed of all the results onto the p-uplets of these suspect markers.
  • the marker being actually "vague” or "indefinite” is the one corresponding to the accepted counter.
  • the robot is controlled to move the body:
  • Station 16 on which control program of the treatment session runs cooperates with a means for specifying a degree of resolution at which recognition of the 3D absolute position of each marker is made.
  • a movement has been computed to nullify offset, it is performed with at least one of the axes of the robotic arm.
  • precision of movement is different for each axe of freedom of the arm.
  • specifications of various resolutions for each axis of freedom of the robotic arm are stored. Therefore, according to instant embodiment, depending on the resolution of nullification of the offset, the computer identifies which axe(s) of movement should be activated to attain said nullifying resolution
  • the patient position is once again corrected until the reference position is reached.
  • the steps for positioning of the patient are repeated for each firing if more than one has been programmed .
  • I ndeed d ifferent firing may be performed one after the other with d ifferent patient orientation.
  • I n most cases, the patient will come to the treatment room at different days (for example one session in each day, each session including several firings).
  • data and/or images of the markers and patient are all stored into the database in relation with the specifying treatment data of the patient. Therefore, when treatment is resumed, new positioning may be performed on the basis of the stored data of any combination of older sessions. Preferably, it is controlled on the basis of the stored data of. the last session because it is more advantageous to compare the new 3D data of the markers with the 3D positions stored the last time the treatment has been conducted . Thus, these positions are used as the new reference positions. Accordingly, time and operations are spared if some markers have moved at least two sessions before.
  • the beam is fired with the patient not moving with respect to the beam.
  • Instant invention may be used to irradiate a large target with at least one beam having a smaller cross-section than that of the target. Therefore, under control of station 16, a convenient sequence of movements and orientations of the patient is performed in relation with the set of proton beams which have been programmed.
  • Means are provided for controlling relative movement of the patient and/or the at least one beam according to a predetermined trajectory to cover the entire space occupied by the at least one tumor. Means could also be provided for varying localization and/or orientation of the patient relative to the at least one treatment beam with external parameters like beam dose rate and duration.
  • the invention may be performed such that during firing the beam, place and/or orientation of the patient with respect to the beam change continuously to treat the targeted tumor.
  • the invented method allows gaining time to position the patient before each firing of a treatment session on a given day and between two sessions.
  • the method of the invention may be performed with an isocentric rotation of the patient under control of the computer 16.
  • the patient isocenter which is linked to the robot is kept without correcting its localization once again. Therefore, the same isocenter being defined at computer 16, a plurality of beams can be fired in sequence, only one rotation movement of the patient around isocenter being performed between two successive firings.
  • a particle accelerator feed out device 200 is provided which is connected to convenient means 212 to feed at least one moving particle beam which is mounted to be rotatable inside a gantry 214. Furthermore, at each point for feeding a proton beam, a system of magnetic lenses is provided to direct central axis of the proton beam with a given angle, the value of which can be determined by electronic control means in relation with any relative movement programmed at the computer unit 204 to localize and/or orientate isocenter and coordinate system of the patient, with reference to the isocenter and a first reference coordinates system associated with gantry 214.
  • a hole is provided through which patient under treatment will be placed at the location shown at sphere 216.
  • Patient is loaded from a docking station as described above toward the treatment place 216.
  • Robot arm controller 210 comprises a trajectory memory which is addressed with particular parameters which are loaded in it during an initialization session before patient is loaded onto the couch 220. With its memory, controller 210 has been learned to control couch 220 and robotic arm 222 to follow a best fit trajectory from the docking station to the treatment place 216 as described above. To move arm 220, controller 210 supplies control signals to actuators of arm 222 via a control link 210a.
  • FIGS. 1 1 , 12 and 13 show an isocenter positioning robot in which same elements are marked with same reference numerals.
  • the isocenter robot 1 principally comprises:
  • the body 4 represents a patient which has been diagnosed with any disease such as a tumour 6 which could be treated with the particle beam, particularly a proton beam produced by a proton-synchrotron 8 in the treatment room 2.
  • the proton-synchrotron 8 is affixed in the treatment room 2.
  • the proton beam propagates along the beam axis 9 up to the head 5 of the patient 4.
  • the isocenter robot 1 and the proton-synchrotron 8 are arranged in such a way that the beam axis 9 intersects the isocenter axis 10.
  • a control means (non shown) is connected to the isocenter robot.
  • the isocenter robot can be combined with the general steps of the method as described above.
  • the six degrees moving means is controlled in order to place the tumour 6 at the intersection between the beam axis 9 and the isocenter axis 10.
  • the chair 1 1 is provided with a plate 3 which is able to incline the head 5.
  • the chair 1 1 can be provided with an actuator 15 in order to move up and down the seat 12 (figure 13) with respect to the chair 1 1.
  • the moving means can further comprises accelerometer tri- axes 16 and inclinometers bi-axes 17 in order to provide the control system with moving data of the chair.

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Abstract

La présente invention concerne des procédés et des dispositifs pour l'application de radiothérapie. Le procédé consiste à détecter des repères justes et des repères inadéquats dans le but de déterminer avec précision la position et l'orientation du corps du patient au sein de la zone de traitement (30) par rapport au faisceau d'axe central (14). Le dispositif comprend un robot (10) que l'on commande pour localiser et/ou orienter le corps du patient par rapport aux repères réels.
PCT/EP2006/007762 2005-08-04 2006-08-04 Procede et dispositif d'application de radiotherapie WO2007017211A2 (fr)

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US11/997,865 US20080317203A1 (en) 2005-08-04 2006-08-04 Method and Apparatus for Applying Radiotherapy
JP2008524452A JP2009502383A (ja) 2005-08-04 2006-08-04 放射線治療を施すための方法および装置
EP06776632A EP1924324A2 (fr) 2005-08-04 2006-08-04 Méthode et appareil pour la radiothérapie

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EP05291664.0 2005-08-04
EP05291664A EP1749550A1 (fr) 2005-08-04 2005-08-04 Méthode et appareil pour la radiothérapie

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WO2007017211A9 (fr) 2007-05-24
JP2009502383A (ja) 2009-01-29
EP1924324A2 (fr) 2008-05-28
WO2007017211A3 (fr) 2007-06-21
EP2286873A1 (fr) 2011-02-23
US20080317203A1 (en) 2008-12-25

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